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FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan NameFRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN
Plan identification number 001

FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

FRIENDS OF GOOD SHEPHERD MANOR INC. has sponsored the creation of one or more 401k plans.

Company Name:FRIENDS OF GOOD SHEPHERD MANOR INC.
Employer identification number (EIN):311190446
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012012-01-01ROBERT GRUNDEY
0012011-01-01ROBERT GRUNDEY
0012010-01-01JACKIE BOWLING2011-10-18
0012007-01-01SUSAN HUTCHISON JACKIE BOWLING2010-06-18

Plan Statistics for FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN

Measure Date Value
2012: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01165
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-010
Total participants2012-01-010
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01154
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-01165
Total of all active and inactive participants2011-01-01165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01165
Number of participants with account balances2011-01-01165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2007: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2007 401k membership
Total of all active and inactive participants2007-01-010
Total participants2007-01-010

Financial Data on FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN

Measure Date Value
2012 : FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-03-28$25,216
Total of all expenses incurred2012-03-28$957,099
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-03-28$951,371
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-03-28$21,918
Value of total assets at end of year2012-03-28$0
Value of total assets at beginning of year2012-03-28$931,883
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-03-28$5,728
Total interest from all sources2012-03-28$3,298
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-03-28Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2012-03-28$0
Was this plan covered by a fidelity bond2012-03-28Yes
Value of fidelity bond cover2012-03-28$150,000
If this is an individual account plan, was there a blackout period2012-03-28No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-03-28$0
Were there any nonexempt tranactions with any party-in-interest2012-03-28No
Contributions received from participants2012-03-28$10,084
Participant contributions at end of year2012-03-28$0
Participant contributions at beginning of year2012-03-28$53,484
Administrative expenses (other) incurred2012-03-28$5,366
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-28No
Value of net income/loss2012-03-28$-931,883
Value of net assets at end of year (total assets less liabilities)2012-03-28$0
Value of net assets at beginning of year (total assets less liabilities)2012-03-28$931,883
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-03-28No
Were any loans by the plan or fixed income obligations due to the plan in default2012-03-28No
Were any leases to which the plan was party in default or uncollectible2012-03-28No
Interest on participant loans2012-03-28$5
Interest earned on other investments2012-03-28$3,293
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-03-28$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-03-28$878,399
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-03-28No
Was there a failure to transmit to the plan any participant contributions2012-03-28No
Has the plan failed to provide any benefit when due under the plan2012-03-28No
Contributions received in cash from employer2012-03-28$11,834
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-03-28$951,371
Contract administrator fees2012-03-28$362
Did the plan have assets held for investment2012-03-28Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-28No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-03-28Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-03-28Yes
Opinion of an independent qualified public accountant for this plan2012-03-28Disclaimer
Accountancy firm name2012-03-28PLANTE & MORAN
Accountancy firm EIN2012-03-28381357951
2011 : FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$233,900
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$224,096
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$222,688
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$212,528
Value of total assets at end of year2011-12-31$931,883
Value of total assets at beginning of year2011-12-31$922,079
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,408
Total interest from all sources2011-12-31$21,372
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$150,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$116,499
Participant contributions at end of year2011-12-31$53,484
Participant contributions at beginning of year2011-12-31$37,714
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$9,804
Value of net assets at end of year (total assets less liabilities)2011-12-31$931,883
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$922,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Interest on participant loans2011-12-31$38
Interest earned on other investments2011-12-31$21,334
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$878,399
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$884,365
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$96,029
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$222,688
Contract administrator fees2011-12-31$1,408
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No

Form 5500 Responses for FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN

2012: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingYes
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2007: FRIENDS OF GOOD SHEPHERD MANOR INC. TAX SHELTERED ANNUITY PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo

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